Roswell Park Comprehensive Cancer Center has implemented three key strategies to improve the success and safety of allogeneic stem cell transplants. The first strategy involves the use of post-transplant cyclophosphamide (PTCy) graft versus host disease prophylaxis for various types of donor transplants. This approach has significantly reduced the rates of acute and chronic graft versus host disease, as well as the need for systemic immune suppression. As a result, patients experience better outcomes and quality of life.
The second strategy focuses on the importance of donor age. Research has shown that using donors under the age of 40 improves transplant outcomes. While matching human leukocyte antigens (HLA) is still important, the use of PTCy allows for HLA-mismatched donors, as long as they are younger than 40. This expands the pool of potential donors and increases the likelihood of finding a suitable match, ultimately improving health equity and transplant success.
The third strategy involves reducing the duration of immune suppression. PTCy-based regimens allow for the efficient and early tapering of immune suppression, minimizing the burden of infections and the risk of relapse. By starting the immune suppression taper within two to three months post-transplant, patients can be off immune suppression within four to six months post-transplant. This approach not only enhances patient safety but also facilitates the transition to post-transplant maintenance therapy.
Overall, these strategies have significantly improved the success and safety of allogeneic stem cell transplants at Roswell Park, resulting in better outcomes, reduced side effects, and enhanced quality of life for patients. The ultimate goal is for patients to be cured of their malignancy, discontinue immune suppression, and return to the care of their referring oncologist and primary care team within two years post-transplant.
